The growing problem of obesity worldwide presents lessons for the UK on how to help people from different cultures lose weight and stay healthy, writes Anthony Leeds
We live in a global village, where an incident thousands of miles away − a tsunami, a nuclear accident, a war − can affect us all.
In the health world, the greatest fear for many is a pandemic, carried from a chicken shack in China right to our doors. But that’s not the most pressing global problem. That’s already here and it’s called obesity.
Obesity is already ruining millions of lives through diabetes, hypertension, heart attacks, arthritis and cancer. It’s costing us billions of pounds; year in, year out.
‘Obesity has reached countries you might not associate with the problem at all’
In fact, the problem is so enormous that we tend to recoil.
I have spent the last year lecturing worldwide, speaking to obesity experts, health ministers and frontline GPs, and it has been remarkably revealing.
Age of extremes
Obesity affects different countries at different levels but two main factors stand out: wealth and education.
At one extreme are the cities in the oil-rich countries of the Middle East, at the other end there are previously impoverished countries where obesity and hunger are neighbours.
A health official in a Middle Eastern country told me, “Thanks to oil and wealth, these people have little to do. They can’t go running about outside so they go shopping and they eat. Most don’t know about the link between overweight and obesity and diabetes, heart disease and so on”.
‘A vision of the future for many parts of the world can be seen in developed countries such as the UK’
In some of these cities, around 40 per cent of residents are obese, with myriad associated problems; diabetes and hypertension are rife. These cities are also good examples of how circumstances can change within two generations − literally from travelling on camels to limousines; from occasional scarcity of food to a surfeit; from a physically active lifestyle to a sedentary one.
Thankfully some are taking action, but women face particular barriers.
In a country where their activity is restricted, where they must have separate gyms, their only option for outdoor activity is to be driven to the shore to exercise in large groups.
Each evening, several limos roll up, out step the women and off they go as a group, under the watchful eyes of bodyguards, to take a brisk walk in the cooler evening air as the sun sets.
This shows the lengths some women have to go to if they want to exercise, keep fit and lose weight.
Obesity has also reached other countries you might not associate with the problem at all.
In a recent visit to West Africa, I saw two distinct communities, separated by the four-inch thick walls of gated compounds. Within were wealthy families with a surfeit of food and who were increasingly affected by obesity. Outside was abject poverty.
This creates a double problem for health services, which have struggled, sometimes successfully, to get to grips with the issues of hunger, malnutrition and infection. Now they have to cope with heart disease and hypertension as well.
A vision of the future for many parts of the world can be seen in well established, developed countries such as the UK.
The US leads the way, with its gargantuan obesity epidemic, but the UK is close behind. Even Australia − still considered home of the body beautiful − has caught up with the UK. Alarmingly it has probably done this in just 15 years, compared with our 30.
There are many global lessons for the UK. First, we must accept that “wealth” (and a surfeit of relatively inexpensive food and of inactivity-inducing electric devices) and obesity are linked. Therefore, many immigrants to the UK are exposed to the radically different Western diet and lifestyle after they arrive.
‘We have to use every piece of information at our fingertips to help all sections of the community avoid obesity-related disease’
Second, the health service needs to respect differaces between cultures and ensure dieting strategies are culturally compatible.
For example, many women of Asian origin can struggle to lose weight. They are under pressure to entertain friends and family and celebrations are hugely significant. Food is at the heart of many occassions and to decline food can cause offence.
This is a problem common to most cultures but perhaps less so in the West where our decades long history of dieting means saying “I’m on a diet” is more, though not always completely, acceptable.
Control of portion sizes and comfort eating are problems shared by people from all cultures. The commonly used strategies of not eating while watching TV, making eating a specific event, preventing snacking, not shopping while hungry, using smaller plates, allowing time for eating and chewing food thoroughly can all work regardless of background.
The health benefits for even relatively modest weight loss are considerable. Loss and maintenance of two or three stone can improve or reverse diabetes, improve or stop obstructive sleep apnoea, and help with weight-related problems such as osteoarthritis.
Thankfully, the UK has a range of highly successful initiatives, such as Counterweight, a weight loss and management programme for use in primary care and in the community.
The UK is better placed than some countries to deliver effective weight loss and maintenance, with a range of successful initiatives. These can deliver substantial cost savings in healthcare expenditure, but it is clear that:
- food availability and physical inactivity, moderated by regional factors, can affect obesity prevalence in all cultural groups, but the underlying principles of prevention and treatment are the same;
- obesity and obesity-related conditions will have to be managed in the UK in the primary care and community setting in most cases, most of the time;
- healthcare professionals are keen to acquire new skills and knowledge in weight management but there is a need to develop a high volume capacity to deliver appropriate training at different levels of complexity.
The UK is already spending millions more pounds per annum year on year as medication bills soar. The cost of medicine for diabetes rose by 41 per cent in the five years to 2011.
We have to use every piece of information at our fingertips to help all sections of the community with evidence-based and cost-effective interventions if we are to have any hope of avoiding the dire consequences of obesity-related disease.
Anthony Leeds is an NHS physician with a special interest in obesity based at the North London Obesity Surgery Service at the Whittington and Central Middlesex hospitals. He is also visiting professor at the University of Copenhagen and employed as medical director of Cambridge Weight Plan.